Hip & Leg Assessment

At Total Care Podiatry the podiatrist will ascertain what dysfunction is occurring in your feet, how this is interacting with the muscles in your back, pelvis and legs and will see what areas in your lifestyle may be placing you at risk of continuing the injury. We will also work together with other health professionals involved in your care to achieve a long term solution.

Conditions this service treats

When you see a heath professional for back pain, do they remark how your ‘pelvis is rotated’ or ‘out’?

Does the treatment only give short term relief before the pain is back again?

It may be that you have a difference in leg length or the alignment of your pelvis is abnormal.

Maybe you’ve had an injury which has resulted in one leg bone being shorter than the other. Alternatively, if the pelvic misalignment is more than mild, it may be caused by a structural back condition called scolosis.

Also, a total hip or knee replacement can result in a shortening of one leg. This can be significant when combined with how your body adapted before the surgery and how it then adapts again after surgery.

Walking should be a fluid motion from the time the heel hits the ground to the point where we step forward and off the foot. Sometimes, if the forefoot and especially the big toe joint becomes jammed, the forward movement is momentarily blocked, forcing other joints to compensate.

The repetition of every step you take is enough to place strain and stress on the muscles and joints leading to inflammation and increased risk of injury.

If you experience back pain and/or pain and fatigue it is important that you have the alignment of your lower limbs and feet analysed to ensure there are no abnormalities that could be contributing to this pain.

How does the treatment work?

If your pelvis is misaligned or you have a difference in leg length, each step is going to place a little more pressure on one side than the other, forcing the joints and muscles to compensate, 4,000 times a day for each leg!

At Total Care Podiatry, we analyse these misalignments after you have seen your back health professional to make sure you are as straight as possible.

We then measure any misalignments with:

Plantar Pressure analysis to measure the amount and timing of pressure underneath your feet in walking and standing. We use our pressure plate to note asymmetry between the pressure on one side to the pressure on the other

A digital pelvic inclinometer (DPI). This equipment has only been available in Australia since early 2015 and the research has shown it to be very accurate. Using the DPI we can better understand why the difference is there and how much is from your pelvis, leg and foot and the compensations and adaptations that have occurred over time.

Treadmill analysis. To see how your body functions with in-shoe corrections we have you comfortably walking on our state of the art treadmill, that has an inbuilt plantar pressure plate. This allows us to examine how your pelvis functions dynamically. We also note symmetry in your stride, and as your body moves up and down with each step, by assessing the differences using the plantar pressure data.

What are the benefits of this treatment

A hip and leg assessment provides objective information which can be compared to results after we implement a treatment plan. We also advise your back health professional on our treatment and ask them to monitor it at your next treatments. Working closely with them, we aim to give you the very best chance of having a long lasting solution to greater mobility.

Paul Graham has been using plantar pressure analysis as part of his clinical practice since first purchasing an Fscan Mat and in-shoe system in 1998. It was a steep learning curve to understand the information behind the pretty colours and what it means. This form of analysis was in its infancy in Australia, and the only way of gaining an appreciable understanding of what the data represented and how could be used in clinical practice was gained through regular email and phone contact with a number of American podiatrists who had been using the Fscan system for many years.

The most well-known of these practitioners is Dr Howard Dannenberg and through this relationship Paul grew to understand the relationship of sagittal plane movement and the importance of how the foot has a significant effect on the rest of the body. In fact Paul’s foundational knowledge of recording, data management and analysis came through Howard’s leadership and the plantar pressure case studies that were shared. This knowledge base was further augmented when Dr Bruce Williams DPM, a protégé of Howard’s training, visited Australia in 2004 and stayed with Paul in Geelong, working and training him in his clinic. In 2005, Paul was invited to Latrobe University to present on his clinical use of plantar pressure in the prescription of the orthotic correction design.

Up until this stage, Paul was combining evidence-based examination and video gait assessment with plantar pressure analysis and, through this orthotic manufacture. The issue was that each part of the assessment used different equipment. In 2006 Paul moved to the Milletrex system, (forerunner of the Freestep software and Sensormedica hardware) and as this combined all aspects of the diagnostic and manufacturing process, he moved to this system. Again a learning curve was required to become familiar with the different parts of the system, however planter pressure is planter pressure and as such, once you understand the recording and data management side, analysis can be done.

In late 2010, the Freestep software program was presented and the engineers in Italy were keen to make it the best on the market. Through the years there have been regular updates making the program more user-friendly and the data presentation more valuable and easy to understand. In fact at present Paul is working with Scott Sorenson and the Italian software developers to enhance this further so that areas of dysfunction and asymmetry are easily noted and measured,. This will be valuable for both the initial assessment and also to easily chart improvement at review appointments. This continued refinement and development, makes Freestep a very valuable clinical tool.

Plantar pressure analysis can only grow in significance as it shows objective data that the eye cannot see. This is now even more important with the discovery that vertical force,( that we describe as pressure), is what causes the overloading that results in tissue damage, rather than any angular anomaly such as an inverted heel or lowering of the medial longitudinal arch. Using Freestep enables Paul to chart improvement effectively and efficiently each visit by simply having a person walk over the mat or treadmill and comparing it to the previous visit; all within five minutes. This is then a record of the patient’s progress, valuable, not only to the treating clinician, but also to any third party who is paying for the treatment.

Video gait assessment is very, very helpful in understanding the biomechanics of the body in motion and should be used in conjunction with planter pressure analysis; however Paul’s clinical use of plantar pressure analysis has led him to the conclusion that it is superior in consistency, ease and speed.